Lithium and Lamictal

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I have been taking medication for bipolar disorder for 21 years, and I have been artificially calm for most of that time. There have been several times when I have tried to discontinue one or all of my medications, and it has always been because of weight gain, which has been my most frustrating side effect. In my family, my weight gain seems to overshadow all of my accomplishments. How I look has always been more important than how I'm doing. After 21 years, I have gotten used to that, but I am still disappointed by it. It really hurts. I was always a normal weight until I started taking medication, and I was athletic too, which I still am, I just don't look like it. I always looked my best, until I started taking medication, and that was very important to my family, and I have to admit that it felt good to me too. Although I have done many disappointing things since my diagnosis with bipolar disorder, it seems like the weight gain from the medication that keeps me stable has been the biggest disappointment to my family, and this has affected my self perception. My weight has fluctuated, but I have been overweight, to some degree, ever since I have taken medication. I wish the way my family treated me didn't affect me, but it does. I've been fighting the weight gain for 21 years, and it has added a lot to my mental stress, but it is a fight I will continue because I aim for good health. And it has gotten a little easier, because I am now taking medication that is supposed to be weight neutral, but I spent so many years gaining weight from medication that it is hard to lose.

Being artificially calm is mostly good. It has allowed me to reach many of my goals, but it has also alienated me from some potential friends and has made me a target of several adult bullies over the years. As a teenager, I was a person who would speak up and fight back, but that is not my first inclination now - unless I am off medication, and then I suddenly take everyone by surprise and end up doing many things I regret - especially because I am not used to acting in such ways regularly. Because I am not used to dealing with my strong emotions, aggressiveness, and rage, it is easy to get overtaken by them.

Because I am artificially gentle, I have to make sure I am around good people, who have my best interests in mind, and won't try to take advantage of me or torture me. I have found that there are certain sadistic people who enjoy finding people they think they can pick on, and they can be relentless. I don't know how naturally calm and gentle people feel. I don't know if they seethe inside. But, I know that I do, and that if someone has wronged me repeatedly, and I am off of my medication, they need to watch out, because although I am not proud of it, I have lashed out physically by fighting and throwing things. This is one reason I need to stay on my medication. I don't have experience with my extreme emotions anymore. Since I have been diagnosed with a severe and persistent mental illness, I don't know if I could ever get control of them. I would love to be off of medication and be free of all of the side effects, but being off of medication has never gone well for me.

I have missed a lot of partying. Although I occasionally have one drink, I don't drink and let loose with my friends, as many people do, because it can be devastating to my stability. This might cause me to take things more seriously and be more bothered by things such as that bully in many workplaces. Other people just go out with their coworkers, drink, and laugh about the awful people they have to work with. I tend to stew about it. In some cases, for years, and that has made work very hard at times. I have usually not been friends with my coworkers, because I haven't been able to party with them, so I haven't had the lighthearted work relationships I imagine that others have. I have only been good friends with one coworker in all of my years of working and I am grateful that we are still friends. It has been an important friendship that has lasted for almost 20 years. I appreciate all of my friends a great deal, I just haven't made them at work. I try to blow off steam by laughing, exercising, praying, and meditating, but sometimes I feel that I have missed partying and just acting goofy in the way that adults only do when they've been drinking.

Because being artificially calm has made me overweight, I don't think it is much appreciated by my family or by society as a whole. However, it has made my friendships stronger and has made it possible for me to have a healthy relationship with my wonderful fiance. He is the greatest source of happiness in my life, and without taking my medication, I would not be able to be the good partner that he deserves. I work hard on giving him my best every day that I am well because he does the same for me, and I appreciate it immensely. He wants me to be healthy and doesn't really care how much I weigh and neither do my good friends. Weight gain has been an interesting way of weeding people out of my life. I feel there is almost more of a stigma with weight gain than with living with a severe mental illness, although, because of the treatments available, the two often go hand-in-hand.

The most important things to me, outside of my relationship with God, are friendships, my relationship with my fiance, my community, my health, and my happiness, and my artificial calm helps me nurture these things and find my place in them. It is hard to accept, but I have accepted the fact that I am not naturally calm and probably have no idea what that is really like. I know I fool a lot of people. Many people have said that I am the calmest and most rational person that they know. They have not seen me off of my medication!

When I was diagnosed with manic depression (now called Bipolar I), at the age of 19, as a student at Indiana University in Bloomington in 1989, I was told that I would have to take lithium for the rest of my life. I started taking it the summer before my sophomore year, and my athletic performance was immediately negatively affected. I quit the soccer team because my coordination had become so poor. I could no longer quickly visually track the ball on the field and I couldn't handle the ball or pass or kick as well. My body felt alien to me.

I spent my sophomore year focusing on school and trying to get used to my new life on medication. I had some friends on a cycling team who knew that I had quit playing soccer, but not really why, and they asked me to ride with them the upcoming summer. After a couple of rides they told me that I was really good and asked me to join the team. So, I joined the team, but something was still off physically, and I knew it. After not performing as well as I would have liked in the first few races, and also having unpleasant problems with dehydration, I decided to quit taking lithium. I told my teammates that I had manic depression, as it was called at the time, and that I had decided to quit taking my medication because it slowed me down too much. My athletic performance improved almost immediately. After discontinuing lithium, I usually placed first, second, or third in my races and was ranked third in the Midwest in women's collegiate cycling. My team also won the Women's Little 500 bike race, which was very exciting! However, I was having trouble concentrating, and feeling very restless, unstable, and pulled in different directions, and also experiencing psychosis at times, so after not graduating on time, I decided to start taking lithium, quit racing, and focus on my studies. Of course, I ended up gaining weight and suffering physically. I did not enjoy feeling slowed down, but I thought it was the price I would have to pay to get on with my life, and I finally graduated.

After graduating, it seemed like the best thing to do would be to continue to take my medication, even though it felt like a weight was tied to my feet when everyone was encouraging me to swim. I was not only physically slowed down, but I also experienced cognitive dulling. When I moved to Louisville, where I still live, I started seeing a new psychiatrist. I remained in his care for 16 years because he had a good reputation, my parents had chosen him for me, and it is really hard to find a good, or even decent psychiatrist. He seemed to believe that I needed to be heavily medicated. At my most highly medicated, I was taking 1800 mg. lithium, 400 mg. Lamictal, 600 mg. Seroquel XR, Ambien to sleep, and Provigil for alertness (which didn't work for me). It felt like way too much medication and I was exhausted all the time. My life was out of balance. Work was my focus because I had little time or energy for anything else. My psychiatrist was resistant to making changes to my medication, insisted that I take lithium, and told me that he would not continue to treat me if I quit taking lithium, as he considered it to be the cornerstone of my cocktail of psychiatric medications. I consulted with a lawyer to discuss filing a lawsuit for malpractice, because I felt I had been turned into a zombie, and she did some research and told me that I was taking enough medication to knock a horse over. Instead of going through with the lawsuit though, I let it go and quit taking my medication without consulting with my psychiatrist. I lost 60 pounds in a year without trying that hard, and felt better, but I ended up becoming manic and being hospitalized again. After that hospitalization I told myself I would take my medication no matter what, and I did. I still had severe mood episodes and I developed serious side effects: hypertension, borderline metabolic syndrome, and sleep apnea. I also gained a tremendous amount of weight. When I was diagnosed with bipolar disorder, I weighed 130 pounds, and after taking medication for close to 20 years, I was up to 278. I had gained 148 pounds. My weight had more than doubled.

After suffering a terrible depression, having ECT, and ending up on disability, I finally decided that the seemingly substandard psychiatric treatment was just too much for me to handle and I couldn't take it anymore, so I found a new psychiatrist. She is a woman who is a few years younger than I am and she understands my concerns about weight gain and side effects and agreed to help me change my medication since I knew I could not just quit taking it myself without serious repercussions. I had educated myself about withdrawal from psychiatric medication and I found that many medications have withdrawals that mimic symptoms of bipolar disorder. She agreed to let me taper off of lithium. When I did, I experienced a bout of hypomania, but I also lost weight, was not thirsty all of the time, my hair became thicker (it had been falling out for years at that point), my psoriasis began to clear up, and I felt sharper and had more energy, and started becoming more active and taking better care of myself, and with alternative medications, my moods began to stabilize.

I have kept regular appointments with my new psychiatrist since 2010 and my health has improved a great deal. I no longer feel extremely slowed down by my medication and it is easier to work, cook, clean, exercise, socialize, spend time with family, go to doctors' appointments, appointments with my therapist, and to be involved in my church and other groups. I have even had time to have a romantic relationship. I met my fiance in early 2013, we became engaged in August 2014, and our wedding date is in October 2015. I love him dearly and am so grateful that I have had time to have a relationship with him, and that it has developed into a healthy partnership. Being in a loving relationship has contributed to my mental stability. I have had some serious mood episodes since we have been together, but having him notice the symptoms and encourage me to get treatment before things get out of hand has really helped me to stay well. I have realized that in the past I waited too long to seek treatment too many times. Mania, psychosis, anxiety, paranoia, and depression can overwhelm me pretty quickly both mentally and physically. I need to take action and get help from my psychiatrist and therapist before I get swept into a downward or upward spiral, and being able to trust my fiance with my well-being has been a relief. We care about each other and care for each other a great deal. We encourage each other to be healthy and our partnership is mutually beneficial.

Now that I have time to live a balanced life, because I am appropriately medicated instead of overmedicated, I focus on taking care of myself physically, mentally, and spiritually. I do not live a perfect lifestyle, but it is greatly improved from how I lived after my first breakdown, and for many years afterward. I work part time and try to keep my stress levels low. I exercise, meditate, spend time with friends and family, cook, clean, see my doctors and therapist regularly, am involved in my church (including singing in the choir, which I love), do volunteer work, and am also involved in two different support groups. Wellness is the focus of my life because if I am not well I can't enjoy anything or be of service to others.

Since the start of this blog I've wanted to write about the medications I take and try because it has been difficult for me to find detailed information of this sort online. The difficulty in writing about medications is that they can often change, and what works for one person probably won't work in exactly the same way for someone else, and a dose that one person might be able to tolerate might be intolerable for someone else. Still, I've wanted to share information about the medications I've taken and am currently taking. Something peculiar that I've noticed is that whenever people discuss these medications they use the brand name, but most people I know take the generics. That is how I have written this blog. I have only taken brand name medications when generics weren't yet available.

As it turns out, Latuda didn't work well for me. I took it for five months and tried to be optimistic about it, hoping that it would have miraculous effects. The biggest problem with taking it was that it made me tired shortly after taking it, so I ended up taking it at night, before going to bed (although I tried to take it with breakfast, lunch and dinner), and I took it with a 350 calorie snack as directed by my psychiatrist. I can't be sure whether the weight gain was a side effect of the medication, or happened as a result of the nighttime snack, but I ended up gaining 10 pounds in the five months that I took it. That was unacceptable to me because I had just spent two years losing 54 pounds. Also, it didn't help me with sleep at all. In fact, it made me quite restless at night. I would fall asleep and then wake up after about an hour and a half. I tried to stay still and fall back asleep, but I ended up staying awake and just tossing and turning in bed. So, I decided to discontinue it. I have now tried Latuda, Geodon, and Saphris, and they have all made me restless. They are similar medications, so this makes sense. My psychiatrist said that Haldol would probably have the same effect because it is similar to those medications. I never noticed that with Haldol because I've never taken it outside of a hospital, I took it a long time ago when I was doing extremely poorly, and I only took it for a short time, but I thought I would mention it here because someone who is sensitive to Haldol might also be sensitive to Geodon, Saphris, and Latuda.

So, my current cocktail is 200 mg. Lamictal, 1200 mg. Trileptal, and 200 mg. Seroquel. The combination of Lamictal and Trileptal has been a good alternative to lithium for me, preventing both mania and depression. I no longer experience extreme thirst and frequent urination, my hair has grown back and thickened, I no longer have a tremor, I've lost a great deal of weight, my thinking seems much clearer, and I don't have to worry about becoming dehydrated when working out. I don't miss taking lithium at all. 200 mg. of Seroquel helps me to sleep very well and my psychiatrist said that it also may be helping me with anxiety. I'm a little slow to get going in the morning, but I definitely have more energy than I have had at higher doses. Besides being a little tired from Seroquel in the morning, I'm not having any noticeable side effects, although I am possibly having metabolic side effects. (It is impossible to know whether my borderline metabolic syndrome is due to my medications or my weight gain, although I feel sure that I wouldn't have gained so much weight without the help of bipolar medications). I take the Lamictal at night, the Trileptal twice a day (one 600 mg. tablet in the morning, and one 600 mg. tablet at night), and the Seroquel at night. I've tried both lower and higher doses of Seroquel and 200 mg. is the least I can take and still sleep well. Over the past two months of taking this cocktail, I've been very productive, my symptoms are under control, I'm getting along well with my friends, boyfriend, family, and coworkers, and I'm exercising a lot, eating well, and steadily losing weight. I've lost the weight I gained while taking Latuda and am now down 55 pounds from my highest weight. I really hope that this cocktail continues to work and I won't have to change it anytime soon if at all. I've been working part time for the past five years and I still have hope that with more stable time under my belt, I will be able to get back to full time work. Of course, I will need to have a job with a flexible schedule that will allow me time off for doctors' appointments since I am being treated for quite a few health conditions now.

In my last few blood tests, my potassium level has been low. I tried eating
more potassium for a few months, but that didn't raise my blood level,
so my doctor prescribed a potassium supplement, and will be monitoring
my potassium level. I've learned that having a healthy level of potassium
should give me more energy, be good for my blood pressure, and may even help me have an easier time
losing weight. Also, potassium level can affect mood, so having the correct level might also help my mental health.
Having just the right blood level of potassium is important because
both low and high potassium can cause serious health problems, so,
besides trying to get enough potassium in your diet, any kind of
supplementation should be monitored by a doctor.

Trying to stay healthy while taking psychiatric medications has been a challenge. The extreme weight gain I experienced raised my blood pressure and gave me sleep apnea. Treating my blood pressure and sleep apnea has made me feel better, this new combination of medications has made me feel better, eating right and exercising has made me feel better, and being able to steadily lose weight has made me feel better and has given me hope that I will be able to get off of my blood pressure medications and CPAP when I lose more weight. So, for a lot of reasons, I am feeling much better than I have in years, and I am very optimistic that my physical and mental health will continue to improve.

I've been taking Latuda for almost two months. I started out taking 40 mg. for 10 days and then my psychiatrist gave me 80 mg. to take. 40 mg. wasn't hard to take, but 80 mg. is more challenging. I think it's a good medication, as far as antipsychotics go, but learning the best time to take it was tricky for me. It makes me feel good during the day if I take it at night. I tried to take it during the day at least 8 times, and each time I felt terrible. A couple of hours after taking it, it became hard to focus, concentrate, and do work. It also made me feel anxious.

The reason that I struggled with what time to take it is that it is supposed to be taken with 350 calories in order to be absorbed properly. That is a small meal, and I'm trying to lose weight. I tried taking it with breakfast, lunch, and dinner, and that bad feeling came on after a few hours and I knew I couldn't tolerate it at those times. The only other time left is later at night, close to my bedtime. If I take it at night I feel good the next day. It doesn't help with sleep, so I'm taking 200 mg of Seroquel for that purpose, with the goal of slowly cutting that dose down. My psychiatrist believes that I need an antipsychotic along with my mood stabilizers, and I have found that if I take Latuda at night, I feel energetic during the day and tend to ruminate less and I also feel less anxious. But, if I take it any time before bedtime I have a very negative experience. So, I've been taking it at night with a peanut butter and jelly sandwich after dinner, and I'm trying to eat less during the day to make up for what feels like an indulgence, although it's necessary.

The most challenging part of my treatment for bipolar disorder has been deciding which antipsychotic to take. The closest second to Latuda that I have tried is Seroquel. Seroquel helped me to sleep at night, and made me feel calm, but it is very sedating when taken during the day, and also caused quite a bit of weight gain when taken at higher doses. So, for now, my regimen is 200 mg. Lamictal, 1200 mg. Trileptal, 80 mg. Latuda, and 200 mg. Seroquel.

Latuda is very expensive, and that makes me nervous. If I ever lost my Extra Help with Medicare, I would not be able to afford it and would have to take something else, and I think that would be Seroquel. It would definitely be an adjustment.

From the beginning of my treatment for bipolar disorder, I've struggled with weight gain. Gaining weight has been my most bothersome side effect, with excessive thirst coming in second. I was diagnosed with bipolar disorder when I was an active, thin nineteen year old. I had been playing soccer since the age of five, as well as doing other sports off and on, and I was always fit. When I started taking lithium, the only medication that was prescribed to me at the onset of my illness, I gained 40 pounds in three months. Because of that, I quit taking lithium and promptly lost the weight. I had gone from 130 pounds to 170 pounds and I could barely run. I couldn't imagine living without running, although now I can.

I wouldn't take medication again until I was twenty four and realized that medication would probably help me move forward in my life, which it did, because about a year after that decision, I graduated from college and got a job. When I decided to take medication again, I knew I would probably gain weight. I fought hard against my appetite, and I always exercised as much as I could, and even participated in sports, but I still gained weight. I was considered to be a compliant patient. Gaining weight was really hard. Not only did I feel different and apart because of my diagnosis, I also felt that I had lost control of the body that I had taken good care of for my entire life, and that had always served me well. I became plus sized and had no idea how I should dress anymore. I also worried about my health. I lost my lifelong identity of being a fit athlete. It was depressing.

I quit taking my medication a few more times over the years, always to relapse and end up in the hospital. Every time I quit taking my medication, it was because I could no longer stand the weight gain, and I always lost weight when I quit taking my medication. When I was thirty two, and hospitalized because of mania, I told myself I would never quit taking my medication again because of gaining weight. That year I had quit taking my medication when I weighed 220. I was off of my medication for about nine months before I became manic, and I got down to 160 in that time, but then I ended up in the hospital.

Even though I quit taking my medication several times over the years because of weight gain, I took it long enough and consistently enough that I was always told that I was a compliant patient. I really hated the idea of being compliant. I felt like it was killing me, but I didn't know what else to do. I had the same psychiatrist from the age of nineteen to the age of forty, and he always asked me what was more important, my weight, or my mental health. He treated my concern about my weight like it was an issue of vanity. I was scared of what my weight was doing to my health, and the weight gain was also terrible for my self esteem.

Finally, the only rational thing to do seemed to be to find a new psychiatrist. I found a young woman who I thought would understand why I wanted to lose weight. She was reluctant to take me off of lithium, but by the time she decided it would be okay to do it, my weight had gotten up to 278 and I had been diagnosed with high blood pressure and sleep apnea. This seemed to be rock bottom as far as my weight was concerned. I never thought I would weigh anywhere near 300 pounds. Lithium was interfering with my weight and my sleep. My sleep study showed that I drank six cups of water during the night. I would wake up thirsty and drink water all night long. I don't think my psychiatrist took my reports of this behavior seriously until the sleep study showed how much I was waking up and drinking water, because of the intolerable thirst caused by lithium. She agreed to take me off of lithium slowly.

I had a bout of mania when I was coming off of lithium last fall, but I stayed out of the hospital. Last spring I was hospitalized for a suicidal depression. It was debilitating and awful, and dragged on for almost two months, but I'm glad I didn't end up taking lithium again. I've been off of lithium for about a year and I've lost 54 pounds. I now weigh 224. I'm glad to be losing weight. 54 pounds lost is significant, but I still have a long way to go. I gained 148 pounds in the time since I decided to start taking medication for bipolar disorder. I always get mad when I think of it. I complained about the weight gain the whole time I was affected by it, and not much was ever done about it until my current psychiatrist decided to take me off of lithium. I knew it was medication that was making me gain weight, but my old doctor blamed my habits for the weight gain. My appetite increased. I was always hungry and thirsty, and I was also lethargic. It's terribly hard to fight those side effects. Now that I am no longer always hungry and thirsty, and I have more energy, I'm losing weight.

I 'm doing a lot of exercise - usually the equivalent of walking five miles or riding my bike twenty miles most days, and some days walking 10 miles or riding my bike 50 miles. I'm also eating well and eating less and less. I'm focusing on eating less fat, less sugar, less sodium, more fiber, and more potassium. This kind of diet is recommended for weight loss and also for control of blood pressure. So, I've lost 54 pounds, but I want to lose 84 more because I'd like to reach my target weight of 140. I'm very happy to be losing weight, but it's hard not to be upset that my medication wasn't changed until I became very overweight and developed health problems because of it. I try really hard to focus on the positive, on the progress I've made, and I'm glad my health is improving.

I was losing weight before I met my boyfriend, but it helps a great deal that he has a mental illness and also had the experience of being an athlete who gained weight because of his medication. He understands the struggle to tame an artificially insatiable appetite. His psychiatrist has also changed his medication to something that allows him to lose weight. We exercise and eat together almost every day, and we really help each other to stay on track. He became fed up with his weight gain after he had gained about 50 pounds and his psychiatrist worked with him to change his medication. His psychiatrist told him that he wasn't going to sit back and watch him get diabetes. I asked my old psychiatrist what would happen if I got diabetes, and he said I would just have to treat it. He didn't take my concern about my health and weight gain seriously.

I'm so glad that I decided to change psychiatrists. I'm currently taking 1200 mg. Trileptal, 200 mg. Lamictal, 300 mg. Seroquel, and 2.5 mg. Saphris. I'm slowly tapering off of Seroquel, down from 400 mg., in the hope that it will decrease my metabolic side effects, and allow me to lose weight faster. My blood pressure is lower, but my LDL cholesterol and triglycerides are still high. I will continue to eat well and exercise, and work to reduce stress, and hope for medication that works without negatively affecting my health. It might take me another year and a half to reach my goal.

I've been having trouble sleeping for years. I'm 42 now and my insomnia started when I was about 14. The diagnosis of bipolar disorder at 19 explained my sleeplessness at the time. About 10 years ago, I started having sleep problems again. I had gained a lot of weight because of bipolar medications, and my psychiatrist suspected that I had sleep apnea. He referred me to a sleep specialist and I had a sleep study. It was determined that I had mild sleep apnea (too mild to treat) and I was told that I would get better sleep if I slept on my side, so that is what I did.

This past summer, I started to suspect that my sleep apnea had gotten worse. I was waking up about 6 or 7 times each night, that I remembered, and I didn't feel rested. Part of the problem was that I was taking lithium, and it was causing extreme thirst, which was compelling me to drink huge amounts of water, and I was in the bathroom all day and all night. I was so thirsty that I would drink more water each time I woke up at night. Whether because of my extreme thirst, or suspected sleep apnea, I wasn't getting good sleep, so I asked my general practitioner to refer me to a sleep specialist, and I let my psychiatrist know about it. My psychiatrist was very interested in learning the results of my sleep study.

My sleep study in October was disastrous. I got out of bed 7 times to go to the bathroom and drank 6 cups of water throughout the night. I only slept for 1 hour, although it seemed like I didn't sleep at all. During that hour, I stopped breathing 16 times because of sleep apnea. That qualifies as moderate sleep apnea and is considered serious enough to treat. I went back for another sleep study in November, and this time I wore a CPAP, a device that blows a gentle stream of air into the nose during sleep to keep the airway open so that you can breathe properly. I slept 7.5 hours and was getting at least 90% oxygen all night, which is in the healthy range of oxygen. It was determined that I would get my own CPAP, and I did.

In December, I met with a respiratory therapist and was fitted with a mask and learned how to use and care for the CPAP. At first, I was given a full face mask. After three weeks of sleeping with it, I decided that it was too uncomfortable, so I went back for another mask. This time I got nasal pillows and they are proving to be much more comfortable.

I was not really excited about using the CPAP at first, but now, at the end of January, I feel so much healthier and more energetic since I've been using it, that I believe it is worth the expense and awkwardness. Also, it is thought that if you have sleep apnea and bipolar disorder, using a CPAP can lessen your experiences of both mania and depression. As an added bonus, I even look better. My eyes look much more rested and my skin looks radiant. Now, in addition to considering it necessary for good mental and physical health, I consider it to be a beauty treatment, and that makes me feel more excited about wearing it.

Unfortunately, many people with bipolar disorder gain weight from the medications, and that causes other health problems, like sleep apnea. There is a possibility that if I lose weight, I will be able to sleep well without the CPAP. Getting to my ideal weight is my next quest. When you get good sleep, you have fewer stress hormones in your body, so it is easier to lose weight.

Since I've been using the CPAP, I've lost 23 pounds. This is probably also the result of a medication change. When my psychiatrist learned, from the sleep study, that I was waking up and drinking water all night, she substituted Trileptal for lithium. I've been asking psychiatrists to take me off of lithium for years, but this was the straw that finally broke the camel's back. I'm also taking Lamictal and Saphris to control my bipolar disorder and I'm doing very well. I'm stable and alert and feeling much more optimistic about the future than I've felt in years.

Tonight, while attending my biweekly support group, one of two support groups I attend, everyone spoke of stress more than usual. We all experience relationship stress, work stress, and the stress of having bipolar disorder itself. It's stressful to think about whether or not to disclose the illness to friends, families, and coworkers, and the mania and sleeplessness that occur at times with the illness, along with the with the seemingly endless depressions, are stressful states to be in.

At many times in my life, stress has sent me over the edge into mania and depression, and has caused me to be hospitalized more times than I can remember. As people with bipolar disorder, it is essential that we try to get a handle on our stress levels. For me, medication, diet, exercise, meditation, lifestyle changes, and therapy, have helped me to manage my stress. When stress seems to be getting out of control, I know I need to do something about it. If I can't handle the stress on my own, it's definitely time to call both my psychiatrist and my therapist. Spending time in a serious state of stress often leads to unpleasant outcomes for me: mania and depression. Hospitalization always seems like a huge setback, plus it's time consuming, often at the worst times, and expensive.

The biggest lifestyle change I've made is going on disability. At the time I went on disability, I was mired in a serious depression that I spiraled into after becoming so inert that I couldn't continue to teach. I had chosen to become a special education teacher because I thought that, as a person who had experienced many years of stability, I was ready to handle the stress, and my diagnosis of bipolar disorder would give me the insight and compassion to help students who were struggling with learning and behavior disorders. I did a good job for almost five years. In fact, I earned several awards and a lot of positive feedback from students, parents, and my principal. But the stress eventually got to me and I became almost immobile and was no longer able to gather the energy to teach. In fact, waking up was hard, as was attending to daily tasks such cooking and cleaning, and even getting dressed. I got to the point where I was barely able to care for myself, and I applied for, and was granted disability.

The period before I went on disability was the lowest part of my life. After I received disability, a lot of the stress I had felt was removed. Ironically, I saw disability as a time to focus on my health. I gradually regained my mental and physical strength. For anyone who has experienced long periods of depression, it's obvious that it's physically unhealthy. Too much time spent in bed or sitting causes muscular weakness, and many people who are depressed don't eat enough, or eat the wrong foods, and the poor nutrition causes a deterioration in health.

After a year on disability, I was able to begin working at a part time job, and now I've been working part time for slightly over three years. I'm feeling much better about myself, and people are beginning to wonder why I'm still on disability. The answer is stress. It has been a breaking point for me in the past and I need enough experience with my stable self to prevent stress from harming me again. I feel that I need a longer period of stability behind me before I go off of disability. My therapist and psychiatrist have shared their opinions that I am not ready to go off of disability yet, if at all.

Although I've been on disability for several years, and have reduced my stress, I've still become manic and have had to be hospitalized twice in the past three years. And I've experienced one serious depression where I was unable to work as many hours as usual for a couple of months. I'm hoping that my medication changes and lifestyle changes will continue to work, and I'll improve in my ability to handle stress to the point where I'll be able to handle the stress of working full time. I want nothing more than to deal with my bipolar disorder in a healthy way and to live the most productive life that I possibly can.